How and how to treat otitis media in adults. Treatment of the perforated stage. Drug treatment of purulent otitis media

Otitis media is an inflammation of the tissues of the middle ear of a viral or bacterial nature. It is often found in the adult population - it accounts for about 30% of the pathology of the ENT organs, but is much more often diagnosed in children.

Why does otitis media occur?

If bacteria are involved in the inflammatory process, pus begins to accumulate in the tympanic cavity, and otitis media at this stage is called acute purulent otitis media.

• In the vast majority of cases, microbes enter the tympanic cavity through tubogenic means - through auditory tube.
• Less common is the hematogenous route of infection entering here - that is, through the bloodstream. This transmission route is noted at such infectious diseases, like tuberculosis, measles, scarlet fever, etc.
• There is also a traumatic way of infection entering the middle ear cavity - with an ear injury with open damage tympanic cavity, as well as through a wound of the mastoid process. The latter cases are characterized by the accumulation of blood in the cavity of the middle ear, which, as is known, is an excellent breeding ground for microorganisms, in particular bacteria.

Inflammatory changes at this stage spread deep into the structures of the middle ear - from the mucous membrane to the periosteum. The mucous membrane swells, erosions and ulcerations appear on it, exudate is released, first serous or serous-bloody, and then purulent in nature. Because the drainage function the auditory tube is damaged, the pus has no outflow path, and its amount progressively increases. When the edematous mucous membrane and the resulting pus fill the tympanic cavity to capacity, the eardrum swells more and more towards the external auditory canal and at some stage its integrity is compromised - perforation occurs. In this case, the patient notes suppuration from the ear, scientifically called otorrhea.

If on at this stage the patient will be provided health care, i.e., adequate treatment is prescribed, inflammation in the tympanic cavity gradually subsides, suppuration from the ear becomes less and less, then stops. The perforated hole is replaced by scar tissue.

Chronic otitis media has 3 forms:

1. Mesotympanitis - the perforation is located in the center eardrum. This is the most favorable form of the disease.
2. Epitympanitis – perforated top part eardrum.
3. Epimesotympanitis - there are 2 or more perforations, and in the tympanic cavity there are polyps and granulations.

Manifestations of otitis media

Otitis media can be acute or chronic.

Acute otitis media in the initial stages is quite mild: the patient is bothered by a feeling of congestion, noise in the affected ear, and autophony is noted - the resonance of the voice in the affected ear. Local phenomena may be accompanied by unexpressed general symptoms: slight increase in body temperature, weakness.

Acute purulent otitis media usually occurs with pronounced symptoms. There are 3 stages:

1. Pre-perforative – lasts from several hours to several days. Against the background of inflammation of the nasopharynx, body temperature rises to febrile levels, severe weakness, concentration deteriorates, appetite decreases. The patient begins to experience pain in the ear, the intensity of which is steadily increasing. The pain becomes excruciating and throbbing, especially when lying down on the affected side. In addition to pain, patients complain of noise, a feeling of fullness in the ear, and hearing loss.
2. Perforated – lasts up to 5–7 days. This stage begins with the appearance of otorrhea - bloody-purulent in nature. The discharge is initially abundant, but over time its quantity decreases. As a result of perforation of the eardrum, the patient notes a sharp improvement in his condition: body temperature tends to normal values, pain in the ear decreases, and hearing improves slightly.
3. Reparative. Characterized by the cessation of otorrhea. The perforated hole is replaced connective tissue, but the patient is still long time the feeling of stuffiness in the ear does not go away. And only when his hearing is completely restored can we consider that the patient has recovered.

In some cases, acute purulent otitis occurs atypically:

• already on initial stage the disease takes on a protracted, asymptomatic character - patients do not feel severe pain, they are only bothered by ear congestion and some hearing loss; perforation of the eardrum does not occur - pus accumulates in the tympanic cavity and then breaks into the surrounding tissues, causing complications;
• otitis occurs with a sharp violation the patient's condition: temperature up to 40 and above C, severe headache, dizziness, nausea and vomiting.

In the case when, even after perforation of the eardrum, the patient did not feel better (the temperature did not decrease, the intensity of ear pain), it is worth thinking about the development of a complication of acute purulent otitis media - inflammation of the mastoid process, or.

Chronic otitis media is manifested by periodic purulent discharge from the ear lasting more than 6 weeks. The discharge may be mixed with mucus or blood and accompanied by an unpleasant odor. With allergic otitis media, the discharge will be watery. During the period of remission, the patient complains of hearing loss, heaviness in the head, autophony, headache and dizziness. Ear pain appears only during periods of exacerbation.

Complications of otitis media

Otitis media is diagnosed by an ENT doctor by interviewing the patient and performing an otoscopy (examination of the ear).

Most a common complication Otitis media is an inflammation of the tissues of the mastoid process. It manifests itself as pain in the ear and behind the auricle, and suppuration from the ear that does not stop for several weeks.

Also, if the perforated stage of otitis does not occur, a breakthrough is possible with the spread of purulent masses to the meninges with the development of severe intracranial complications. Their manifestations can be different - from headaches, dizziness, paresis of cranial nerves, seizures to coma of varying degrees.

Diagnostics

Patient complaints and anamnesis of this disease will allow the specialist to suggest a diagnosis of “otitis media”.

Because children early age cannot say what exactly is bothering them, and preschoolers and primary schoolchildren do not always correctly name this or that symptom, the doctor should be extremely attentive and refer the child for a consultation with an otolaryngologist in the case of:

• a sharp disturbance in the general condition of the baby;
• signs of severe pain;
• fever lasting more than three days;
• two sleepless nights;
• painful reaction of the child to pressing on the tragus of the affected ear or palpation and percussion of the mastoid process;
• smoothness of the postauricular fold, protrusion of the auricle;
• purulence from the ear.

When examining the eardrum, or otoscopy, the following changes will support the diagnosis:

• retraction or swelling of the eardrum;
• its hyperemia and swelling;
• the presence of a perforation hole in any part of it; pus is released from the hole;
• scar tissue at the site of the perforation hole.

To determine the degree of hearing loss, the patient undergoes a so-called tuning fork study.

A general blood test will show the presence bacterial inflammation in the body (leukocytosis, shift leukocyte formula to the left, increased ESR).

Exudate taken from the site of inflammation can be examined to determine the bacteria in it and their sensitivity to antibiotics.

Treatment of otitis media

At the initial stage of the disease, the patient is recommended to undergo a daily procedure of catheterization of the auditory tube with washing it with solutions of antiseptics, anti-inflammatory and vasoconstrictor drugs. Locally - vasoconstrictor drops in the nose.

During the exudative stage, the introduction into the external auditory canal of a cotton wool with osmotol - a mixture of glycerin and 90% ethyl alcohol in a 1:1 ratio. Following the turunda, a cotton swab with Vaseline is inserted into the ear canal. Turunda stays in the ear for about a day, providing warming, analgesic and dehydrating effects. In addition to turunda with osmotol, the patient receives vasoconstrictor drops in the nose.

For purulent otitis, the patient is also prescribed a compress with osmotol, if there is no effect after a day, it is necessary to decide on paracentesis - piercing the eardrum with subsequent sanitation of the tympanic cavity.

Immediately after the diagnosis of acute suppurative otitis media, the patient should be prescribed antibiotics. Since the type of pathogen is unknown at this stage, the prescribed drug should be active against most of the likely causative agents of otitis. This may be an antibiotic from the group of penicillins or cephalosporins.

Antipyretic and painkillers should also be prescribed at this stage.

When there is an outflow of pus through a perforated hole, antibacterial drugs in the form of solutions can be added to treatment. local application. It is important that they do not have an ototoxic effect (such as Gentamicin), otherwise the patient risks losing his hearing forever.

The reparative stage of acute purulent otitis media does not require any special medical procedures. However, observation by an ENT doctor is necessary if the perforation was large enough to completely control the scarring process.

When treating chronic otitis media, it is important to restore the free flow of pus from the tympanic cavity. If otitis media is limited, regular rinsing of the cavity and external auditory canal may be sufficient. However, in most cases, granulations and polyps present in the middle ear must be removed surgically.

Antibiotics and antiallergic drugs may be prescribed as medications.
Don’t forget about physical procedures - electrophoresis and microwave therapy will relieve inflammation and improve microcirculation in tissues.

Prevention

With otitis media, the patient can be prescribed antibacterial and anti-inflammatory drugs for both systemic use, and locals.

There is no specific prevention for otitis media. In order to prevent the development of this disease, it is important to promptly diagnose and treat diseases that can lead to it: rhinitis,

A disease such as purulent otitis affects the middle cavity of the ear and has quite a characteristic features. IN acute phase in adults, fluid with purulent impurities flows from the ear, and when it accumulates inside, pain and bloating are felt. To prevent the pus from flowing deeper and causing complications that can lead to hearing loss, it is necessary to treat the disease correctly and in a timely manner.

Symptoms and features

Purulent otitis media– this is a complicated degree of ear disease inflammatory in nature. In this case, pus is found in the ear of an adult, which, after a rupture of the eardrum, flows out through the ear canal.

Symptoms of purulent otitis are as follows:

• headache;
• general weakness;
• loss of appetite;
• temperature increase;
• intoxication;
• ear pressure, stuffiness;
• sensation of gurgling and fluid transfusion;
• severe pain, shooting and sharp;
• noise in ears;
• hearing loss;
• bad smell and ear discharge.

Acute purulent otitis media manifests itself abruptly and is characterized by a rapid course. It is the discharge in the form of purulent exudate that distinguishes it from other forms of the disease. This type of otitis is called perforative. To prevent pus from flowing into inner ear, it is important to achieve its passage through a breakthrough of the eardrum.

If there is pus in the ear, but there is no high temperature, this is considered normal for otitis media. However, this does not mean that the body is healthy, because the disease continues to progress and can become chronic.

The sore ear of an adult during the period of illness looks swollen and may have reddened areas of the skin. When suppuration occurs, a viscous liquid with an unpleasant odor and a yellowish tint is released from the ear canal. The resulting crusts can cause irritation, but if you try to clean them mechanically, there is a possibility of damaging the outer ear and spreading inflammation.

Depending on what signs are observed in the patient, there are three main stages of purulent otitis media:

• Preperforative. This is the active phase when the disease progresses from the initiation of a focus of inflammation to the accumulation of a large amount of purulent exudate. The secretion fills the middle ear, causes discomfort, pain and is an excellent breeding ground for bacteria.
• Perforated. The accumulation of pus leads to rupture of the eardrum or requires its mechanical puncture. Through the hole, the liquid flows out and the patient’s condition is relieved.
• Reparative. If there are no prerequisites for the recurrence of the disease, the bacteria are destroyed and the pus is completely cleared, the membrane heals and the patient recovers within a few days.

The faster the disease will be complete cycle, the sooner recovery will occur.

Reasons for development

Acute purulent otitis media is a continuation exudative form diseases. Initially, swelling of the auditory tube occurs, and then it enters the middle ear. serous exudate. As the disease progresses, bacteria begin to multiply in the discharge, causing purulent otitis media. The products of their vital activity are pus.

The main causes of purulent otitis media are as follows:

• Infections. They get into the ear pathogens, which provoke pathological processes in soft tissues and inflame the mucous membrane. If colds, flu, sinusitis and other similar diseases are not treated, streptococci and pneumococci can easily enter the hearing organs in one way or another, for example, if the secretion flows through the eustachian tube from the nose due to improper blowing of the nose, otitis media develops.
• Injuries. If the ear is damaged mechanically, an infection may appear inside the wound. In addition, there is a risk of acoustic and atmospheric influences. In case of violation normal condition organ and the proliferation of bacteria in the damaged area, the ear festers and becomes inflamed. In adults, this may be a consequence of surgery or blowing out the auditory tube for catarrhal otitis media.
• Allergy. If the ear is irritated by allergens or there is allergic rhinitis, there are high risks of development purulent form diseases. It is advisable to limit contact with such irritants.
• Weakening of the immune system. General weakening of the body's defenses and the impact chronic diseases may become a prerequisite for otitis media. If there are no obvious factors that can cause ear inflammation, pay attention to general state your health.

These reasons are provocateurs of purulent otitis media, but this is only a basic list; in fact, there are many more of them.

At improper treatment purulent otitis may occur Negative consequences. First of all, you should take care of maintaining the health of the eardrum, because extensive perforation and contact with pus can lead to its destruction. Also, if pus flows into distant parts, it can provoke the development of internal otitis media or tumors in the ear. For adults and children, consequences such as the release of a pathological process into the cranial cavity and brain are equally possible. When pus enters the bloodstream, sepsis can develop.

Treatment with traditional methods

Since purulent otitis media is a rather dangerous disease, it must be treated immediately. To avoid complications in the future, it is better to visit an otolaryngologist for consultation. Treatment of purulent otitis covers traditional therapy And surgical methods. If there are no complications, you can get by with medications and physiotherapeutic procedures.

To eliminate the disease, it is necessary to get rid of the cause that caused the ear inflammation. In most cases, anti-inflammatory and antiviral drugs. Analgesics are used to relieve pain. If the cause lies in allergies, the doctor will prescribe antiallergic drugs.

To prevent pus from flowing into the inner ear, you need to get rid of bacteria in the ear as soon as possible. To do this, instill antibacterial and antiseptic drugs. If there is pus in large quantities has flowed into the external auditory canal, most likely the integrity of the eardrum has been compromised, then the use of any local medications should be monitored by a doctor.

Acute suppurative otitis media in adults is often treated with antibiotics. To select suitable drugs for the treatment of purulent otitis, tympanocentesis, that is, analysis of secretions, can be performed.

It is important to wait for the pus to drain through the auditory tube or perforation of the eardrum. To prevent pus from flowing deeper into the ear, you should sleep on the sore side. When pus flows profusely from the ear, you should not apply heat or compresses. Warming the ear will only intensify pathogenic processes.

Physiotherapy can include UHF and ultraviolet, blue and red lamp illumination, as well as pneumomassage to prevent pus from flowing into the pockets in the ears, to restore the mobility of the eardrum and resolve the scars on it.

Surgical intervention

Surgical treatment of purulent otitis may be necessary in several cases. Let's look at them in more detail:

• Paracentesis. To prevent the ear from becoming infected, if there is no natural perforation of the eardrum, myringotomy or paracentesis may be necessary. This is a puncture of the eardrum of the affected ear with a miniature needle. Through the hole, pus flows out, and medications can also be administered into the middle ear cavity. To prevent the pus from flowing back and the puncture from healing prematurely, a shunt is installed. Such operations are performed less frequently in adults than in children. The shunt stays in the ear for several months and then falls out on its own.
• Myringoplasty. If an adult has purulent phase otitis with perforation of the eardrum; myringoplasty may be necessary to restore it. If the ear is not seriously damaged, the membrane will repair itself.
• Tympanoplasty. An adult may develop consequences in the form of chronic otitis, especially if pus has flowed into the pockets middle cavity. To reconstruct and eliminate foci of suppuration, it is necessary to do tympanoplasty, otherwise the ear will have difficulty hearing.

If there is no need for surgery, it is better to limit yourself to standard therapy. For adults, it is important not to let otitis media progress to the stage of suppuration, as this brings discomfort, pain and negative consequences.

Otitis is an inflammation of the ear, a general term for any infectious processes in the organ of hearing. Depending on the affected part of the ear, there are outer, middle and internal otitis(labyrinthitis). Otitis is common. Ten percent of the world's population will suffer from otitis externa during their lifetime.

Every year, 709 million new cases of acute otitis media are registered worldwide. More than half of these episodes occur in children under 5 years of age, but adults also suffer from otitis media. Labyrinthitis, as a rule, is a complication of otitis media and occurs relatively rarely.

Anatomy of the ear

To better understand the topic being presented, it is necessary to briefly recall the anatomy of the hearing organ.
The components of the outer ear are the auricle and the auditory canal. The role of the outer ear is to capture sound waves and conduct them to the eardrum.

The middle ear is the eardrum, the tympanic cavity containing the chain of auditory ossicles, and the auditory tube.

In the tympanic cavity, sound vibrations are amplified, after which the sound wave travels to the inner ear. The function of the auditory tube, which connects the nasopharynx and middle ear, is ventilation of the tympanic cavity.

The inner ear contains the so-called cochlea, a complex sensory organ in which sound vibrations are converted into an electrical signal. The electrical impulse follows auditory nerve into the brain, carrying encoded information about sound.

Otitis externa

Otitis externa is an inflammation of the ear canal. It can be diffuse, or it can occur in the form of a boil. With diffuse external otitis, the skin of the entire ear canal is affected. A boil is a localized inflammation of the skin of the outer ear.

Otitis media

With otitis media, the inflammatory process occurs in the tympanic cavity. There are many forms and variants of the course of this disease. It can be catarrhal and purulent, perforated and non-perforated, acute and chronic. With otitis media, complications can develop.

The most common complications of otitis media include mastoiditis (inflammation of the behind-the-ear part of the temporal bone), meningitis (inflammation of the membranes of the brain), brain abscess (abscess), labyrinthitis.

Labyrinthitis

Internal otitis is almost never an independent disease. It is almost always a complication of inflammation of the middle ear. Unlike other types of otitis, its main symptom is not pain, but hearing loss and dizziness.

Causes of otitis media

• After exposure to contaminated water- more often otitis externa occurs after water containing the causative agent gets into the ear. That is why the second name of this disease is “swimmer’s ear.”
• Trauma to the skin of the external auditory canal- in addition to the presence of infection in the water, there must also be local conditions, predisposing to the development of inflammation: microcracks in the skin, etc. Otherwise, our every contact with unboiled water would end in the development of inflammation in the ear.
• Complication of ARVI, sinusitis- in this case, the causative agent of otitis media penetrates into the tympanic cavity from a completely different direction, the so-called rhinotubal route, that is, through the auditory tube. Usually the infection enters the ear from the nose when a person is sick with ARVI, runny nose or sinusitis. With severe inflammation of the middle ear, the infection can spread to the inner ear.
• At infectious diseases, kidney diseases, diabetes mellitus, hypothermia against the background of reduced immunity, the risk of developing inflammation in the middle ear increases. Blowing your nose through 2 nostrils (incorrectly), coughing and sneezing increase pressure in the nasopharynx, which leads to infected mucus entering the middle ear cavity.
• Mechanical removal earwax - it is a protective barrier against infections.
• High air temperature and high humidity.
• Foreign objects entering the ear.
• Use of hearing aids.
• Diseases such as,.
• The causes of the development of acute otitis media are also genetic disposition, immunodeficiency states,.

Pathogens

Otitis externa can be caused by bacteria or fungi. Microorganisms such as staphylococcus are especially common in the ear canal. For fungi of the genus Candida and Aspergillus, the skin of the ear canal is generally one of the favorite places in the body: it is dark there, and after bathing it is also damp.

The causative agents of otitis media, and therefore internal, can be viruses and bacteria. Fungal infection of the middle ear also occurs, but much less frequently than the outer ear. The most common bacterial pathogens of otitis media are pneumococcus, Haemophilus influenzae, and Moraxella.

Clinical picture - symptoms of otitis media

• Pain is the main symptom of otitis media. The intensity of pain may vary:
  • from barely perceptible to unbearable
  • character – pulsating, shooting

  It is very difficult, most often impossible to distinguish on your own painful sensations with external otitis from pain due to inflammation of the middle ear. The only clue may be the fact that with otitis externa, pain should be felt when touching the skin at the entrance to the ear canal.

• Hearing loss is a variable symptom. It may be present in both otitis externa and otitis media, and may be absent in both of these forms of ear inflammation.
• Temperature increase- most often there is an increase in body temperature, however, this is also an optional sign.
• Ear discharge with external otitis they almost always occur. After all, nothing prevents the inflammatory fluid from being released.

With otitis media, if there is no perforation (hole) in the eardrum, there is no discharge from the ear. Suppuration from the ear canal begins after a communication appears between the middle ear and the ear canal.

I would like to emphasize that perforation may not form even with purulent otitis media. Patients suffering from otitis media often ask, where will the pus go if it does not break out? It's very simple - it will come out through the auditory tube.

• Ear noise (see, ear congestion is possible with any form of the disease.
• With the development of inflammation inner ear may appear).

Acute otitis media occurs in 3 stages:

Spicy catarrhal otitis media - the patient experiences severe pain, intensifying at night, when coughing, sneezing, it can radiate to the temple, teeth, be stabbing, pulsating, boring, hearing and appetite decrease, weakness appears and heat up to 39C.

Acute purulent otitis media- accumulation of pus occurs in the middle ear cavity, followed by perforation and suppuration, which can occur on the 2-3rd day of illness. During this period, the temperature drops, the pain decreases, the doctor can make a small puncture (paracentesis) if the eardrum has not ruptured on its own.

Recovery stage- suppuration stops, the defect of the eardrum closes (fusion of the edges), hearing is restored within 2-3 weeks.

General diagnostic principles

In most cases, diagnosing acute otitis is not difficult. High-tech research methods are rarely needed; the ear is quite visible to the eye. The doctor examines the eardrum with a head reflector (a mirror with a hole in the middle) through the ear specula or a special optical device- otoscope.

An interesting device for diagnosing otitis was developed by the famous Apple corporation. It is an otoscopic attachment for a phone camera. It is assumed that with the help of this gadget, parents will be able to photograph the child’s eardrum (or their own) and send the photos for consultation to their doctor.

Diagnosis of external otitis

When examining the ear of a patient suffering from otitis externa, the doctor sees redness of the skin, narrowing of the ear canal and the presence liquid discharge in its lumen. The degree of narrowing of the ear canal may be such that the eardrum is not visible at all. In case of inflammation of the outer ear, other examinations other than examination are usually not necessary.

Diagnosis of otitis media and labyrinthitis

In case of acute inflammation of the middle ear, the main way to establish a diagnosis is also examination. The main signs that make it possible to diagnose “acute otitis media” are redness of the eardrum, limited mobility, and the presence of perforation.

• How is eardrum mobility checked?

The person is asked to puff out his cheeks without opening his mouth, that is, to “puff out his ears.” This maneuver is called the Valsalva maneuver, named after the Italian anatomist who lived at the turn of the 17th and 18th centuries. It is widely used by divers and divers to equalize pressure in the tympanic cavity during deep-sea descent.

When a stream of air enters the middle ear cavity, the eardrum moves slightly and this is noticeable to the eye. If the tympanic cavity is full inflammatory fluid, no air will enter it and there will be no movement of the eardrum. After the appearance of pus from the ear, the doctor may observe the presence of perforation in the eardrum.

• Audiometry

Sometimes, to clarify the nature of the disease, audiometry (hearing test using a device) or tympanometry (measurement of pressure inside the ear) may be needed. However, these hearing examination methods are more often used when chronic otitis media.

The diagnosis of labyrinthitis is usually made when, against the background of ongoing otitis media, hearing acuity suddenly drops sharply and dizziness appears. Audiometry in such a situation is mandatory. You also need an examination by a neurologist and a consultation with an ophthalmologist.

• CT and radiography

Need for X-ray studies occurs when there is a suspicion of complications of the disease - mastoiditis or intracranial spread of infection. Fortunately, such cases are rare. In situations where complications are suspected, it is usually performed CT scan temporal bones and brain.

• Bacterial culture

Is a smear necessary for otitis media? bacterial flora? It is not easy to give a definite answer to this question. The problem is that, due to the peculiarities of bacterial cultivation, the answer from this examination will be received 6-7 days after the smear is taken, that is, by the time the otitis media has almost passed. Moreover, with otitis media without perforation, a smear is useless, since the microbes are behind the eardrum.

Still, it’s better to do a smear. In the event that the use of first-line medication does not bring recovery, after receiving the results of a bacterial study, it will be possible to adjust the treatment.

Treatment of external otitis

The main treatment for otitis externa in adults is ear drops. If a person does not have an immunodeficiency (HIV infection, diabetes), antibiotic tablets are usually not needed.

Ear drops can contain only an antibacterial drug or be combined - contain an antibiotic and an anti-inflammatory substance. The course of treatment takes 5-7 days. Most often used for the treatment of external otitis:

Antibiotics:

• Cipropharm (Ukraine, ciprofloxacin hydrochloride)
• Normax (RUB 100-140, norfloxacin)
• Otofa (170-220 rubles, rifamycin)

Corticosteroids + antibiotics:

• Sofradex (RUB 170-220, dexamethasone, framycetin, gramicidin)
• Candibiotic (RUB 210-280, Beclomethasone, lidocaine, clotrimazole, Chloramphenicol)

Antiseptic:

• (250-280 RUR, with sprayer)

The last two drugs also have antifungal properties. If otitis externa is of fungal origin, they are actively used antifungal ointments: clotrimazole (Candide), natamycin (Pimafucin, Pimafucort).

Besides ear drops, for the treatment of external otitis, the doctor may recommend an ointment with active substance Mupirocin (Bactroban 500-600 rubles, Supirocin 300 rubles). It is important that the drug does not have negative action on normal microflora skin, and there is evidence of activity of mupirocin against fungi.

Treatment of otitis media and labyrinthitis in adults

Antibacterial therapy

The main treatment for otitis media is an antibiotic. However, treatment of otitis media with antibiotics in adults is another controversial issue. modern medicine. The fact is that with this disease the percentage of spontaneous recovery is very high - more than 90%.

There was a period of time at the end of the 20th century when, in a wave of enthusiasm, antibiotics were prescribed to almost all patients with otitis media. However, it is now considered acceptable to do without antibiotics for the first two days after the onset of pain. If after two days there is no tendency to improve, then an antibacterial drug is prescribed. All types of otitis media may require oral pain medications.

In this case, of course, the patient must be under medical supervision. The decision about the need for antibiotics is a very important one and should only be made by a doctor. On the scales on one side there are possible side effects antibiotic therapy, on the other hand, the fact that every year in the world 28 thousand people die from complications of otitis media.

The main antibiotics used in the treatment of otitis media in adults:

• Amoxicillin - Ospamox, Flemoxin, Amosin, Ecobol, Flemoxin solutab
• Amoxicillin with clavulanic acid - Augmentin, Flemoclav, Ecoclave
• Cefuroxime - Zinnat, Aksetin, Zinacef, Cefurus and other drugs.

The course of antibiotic therapy should be 7-10 days.

Ear drops

Ear drops are also widely prescribed for inflammation of the middle ear. It is important to remember that there is a fundamental difference between drops that are prescribed before perforation of the eardrum and after it appears. Let me remind you that a sign of perforation is the appearance of suppuration.

Before perforation occurs Drops with an analgesic effect are prescribed. These include drugs such as:

• Otinum - (RUB 150-190) - choline salicylate
• Otipax (220 rubles), Otirelax (140 rubles) - lidocaine and phenazone
• Otizol - phenazone, benzocaine, phenylephrine hydrochloride

There is no point in instilling antibiotic drops in this phase, since inflammation is going on behind the eardrum, which is impenetrable to them.

After perforation appears the pain goes away and you can no longer use anesthetic drops, as they can harm the sensitive cells of the cochlea. If perforation occurs, there is access for drops inside the middle ear, so drops containing an antibiotic can be instilled. However, ototoxic antibiotics (gentamicin, framycetin, neomycin, polymyxin B), drugs containing phenazone, alcohols or choline salicylate should not be used.

Antibiotic drops, the use of which is acceptable in the treatment of otitis in adults: “Tsipropharm”, “Normax”, “Otofa”, “Miramistin” and others.

Paracentesis or tympanotomy

In some situations, with inflammation of the middle ear, you may need a small surgical intervention– paracentesis (or tympanotomy) of the eardrum. It is believed that the need for paracentesis arises if, against the background antibacterial therapy for three days the pain still continues to bother the person. Paracentesis is performed under local anesthesia: A small incision is made in the eardrum with a special needle, through which pus begins to come out. This incision heals well after the suppuration stops.

Treatment of labyrinthitis is complex medical problem and is carried out in a hospital under the supervision of an ENT doctor and a neurologist. In addition to antibacterial therapy, agents are needed that improve microcirculation inside the cochlea, neuroprotective drugs (protecting nerve tissue from damage).

Prevention of otitis

Preventive measures for otitis externa include thoroughly drying the ear canal after bathing. You should also avoid traumatizing the ear canal - do not use keys and pins as ear instruments.

For people who often suffer from inflammation of the outer ear, there are drops based on olive oil, providing skin protection when swimming in a pond, for example, “Vaxol”.

Prevention of otitis media consists of general strengthening measures - hardening, vitamin therapy, taking immunomodulators (drugs that improve immunity). It is also important to promptly treat nasal diseases, which are the main causative factor inflammation of the middle ear.

Ear inflammation can have serious consequences for a person. An irresponsible attitude towards your health and this sensitive organ can lead to hearing loss and other complications. Otitis media in adults is a disease that needs to be taken seriously and you need to know its symptoms, consequences and treatment. In this article, the reader will receive all the necessary information, learn about medications and traditional methods treatment, preventive measures.

Characteristics of the disease

The human ear has a complex structure and consists of an outer, middle and inner part. Depending on this, otitis media can be localized in different tissues of the ear.

The outer ear is the auditory canal itself in the form of the auricle.

The following inflammations of the outer ear are distinguished.

• perichondritis – infection of the cartilage followed by an inflammatory process;
• diseases skin( , ) provoke otitis media;
• diffuse otitis occurs if there is a skin injury with infection;
• mycosis - the development of fungus on the skin of the ear;
• when they become inflamed sebaceous glands. Inflammation occurs due to the entry of pathogenic microbes into the roots of miniature hairs;
• otohematoma – hemorrhage in an organ, accompanied by the development of pathogens and inflammation.

The middle ear is formed by the tympanic cavity, which includes the membrane, and the auditory tube, which balances within the organ.

May cause the following diseases:

• inflammation of the tympanic cavity and, as a result, the membrane;
• inflammatory process in the auditory tube;
• infection of the skull bone as the next stage in the development of otitis media.

Infections of this part of the ear with otitis media are divided into acute and chronic.

Acute otitis media is characterized by inflammation of the middle ear mucosa and discharge of pus. Purulent otitis in adults is provoked by the penetration of infection through the connecting channels (through the auditory, eustachian tube) from the nasopharynx; this often occurs during the development of ARVI, but can be caused by more specific reasons:

• strong changes when rinsing or blowing your nose;
• development various infections: , typhus, . The disease is transmitted through blood;
• reduced, including, or.

Chronic otitis also affects the mucous membrane and forms purulent inflammation.

Otitis occurs due to:

• untreated acute otitis media in the presence of other infectious diseases;
• disturbances of normal nasal breathing (in case of allergies or nasal injuries);
• suppressed immune system;
• use of drugs that inhibit the body’s protective function.

The inner ear consists of a labyrinth of organs.

An infection can get into this part of the ear due to chronic otitis media, as well as in the case of:

• occurrence of severe injury;
• development (inflammation of the brain);
• progression.

Symptoms and consequences

Attention! Signs of otitis in adults differ depending on the location of the inflammation and the nature of its course.

When otitis externa occurs in the auricle, the symptoms can be seen with your own eyes:

• perichondritis is characterized by swelling in the form of tuberosity and pain in the auricle itself;
• at infectious lesions the skin develops redness, crusting, and weeping of the skin;
• diffuse otitis media causes intense itching and pus from the ear, painful sensations if you touch or pull the ear;
• with the progression of mycosis, characteristic signs appear: a feeling of congestion and noise, deterioration in hearing ability, itching, unpleasant odor;
• It is characterized by severe pain in the ear, which radiates to the face, neck and teeth. A lump with yellowish pus appears on the ear, painful when pressed. Pain interferes with talking and chewing food;
• with otohematoma, a tumor-like formation occurs bright color(blue and purple), does not cause pain.

Damage to the middle ear carries a greater risk to human health.

Advice! To minimize the consequences it is recommended early diagnosis And timely treatment otitis media.

It is characterized by the following symptoms:

• pronounced congestion and noise;
• a clear echo (resonance) from your own voice in the inflamed ear;
• shooting pain with abscess of the tympanic cavity. The development of infection leads to membrane rupture and hearing loss;
• in some cases, there is an increase in body temperature (not higher than 40 degrees Celsius);
• general weakness in the body;
• throbbing pain;

When otitis media passes into the chronic stage, there is a constant discharge of pus, hearing deteriorates, and may be accompanied by regular pain in the head and ear.

Internal otitis affects vestibular apparatus patient and manifests itself:

• severe dizziness, loss of coordination;
• vomiting;
• increased heart rate;
• pale skin;
• significant hearing loss.

Not taking the symptoms of otitis seriously, insufficient treatment may cause complications. Progressive ear inflammation can cause:

1. Epitympanitis is inflammation of the temporal bone.
2. Facial nerve paralysis.
3. Skull hernias.
4. Brain abscess.
5. Complete hearing loss.

Attention! These consequences require urgent medical, including surgical, intervention!

Diagnosis and treatment

Before you start treating otitis media, you should visit a doctor for an examination. An ENT specialist makes a diagnosis based on a survey and signs identified during an ear examination (otoscopy). The doctor also checks hearing acuity and analyzes the results of a bacteriological blood test. If necessary, X-rays and tomography of the skull are performed.

Treatment of otitis in adults depends on the characteristics of the disease. The patient uses drops and takes medications, but in severe cases surgical intervention is used in an inpatient setting.

Attention! If timely measures are taken, all treatment can be carried out at home.

Treatment for otitis externa includes:

• use of antibacterial, restorative ointments;
• cold and compresses;
• extraction of fluid, surgical opening of ulcers;
• taking antibiotics;
• lubricating bumps and boils with iodine, wetting tampons boric alcohol and laying in the ears;

For improvement general well-being and reducing the temperature, paracetamol is prescribed. Physiotherapy may be prescribed in the clinic: UHF and ultraviolet radiation, especially for chronic otitis media.

Acute otitis media must be treated promptly, because the risk of complications in this case is high.

• A catheter is inserted into the auditory tube to administer antibacterial substances that eliminate inflammation. This must be done daily to eliminate pathogenic bacteria.
• The eardrum is massaged using a narrowly directed air flow.
• The use of imuprofen and paracetam is indicated.
• Drops are used for otitis media.
• Warm compresses are made daily: cotton wool soaked in Vaseline and soaked in alcohol with glycerin is inserted into the ear canal. This compress relieves swelling and warms well.

In some cases (with severe pus), the surgeon punctures the eardrum. Hormones and antibiotics for otitis in adults in this case are administered through a catheter.

Attention! After puncture, drops for otitis media are contraindicated.

If there is no improvement in this case, trepanation of the mastoid process of the middle ear is performed.

Chronic otitis media is treated with a slightly different program, since the factor of efficiency is secondary here. In this case, therapy is indicated antibacterial drugs, rinsing and infusion of medications, as well as physiotherapeutic measures:

• rinse sore ear warm solutions boric acid, furacillin, hydrogen peroxide;
• rinse with antibiotics (with added hormones);
• antibiotics and furacillin (along with other medications: quinozol, dimexide, etc.) are poured into the ear canal;
• UFO and UHF.

If a complication occurs, treatment takes a serious turn and involves the use of surgical means.

Inflammation of internal otitis is eliminated with the help of enhanced antibiotic and vitamin therapy. In this case it is required surgery(to avoid hearing loss): in the second week of taking the medication, a cleansing operation is performed.

Traditional recipes for the treatment of otitis media

Over many centuries and millennia, people have developed natural ways to eliminate inflammation in the ear. Treatment of otitis at home involves the use of the following recipes.

For external otitis in adults, two-hour compresses of warm alcohol solution(ratio of water and alcohol: one to one).

A decoction of bay leaves is also effective: put 5 medium leaves in a glass of water, bring to a boil and let it brew. Take 2 tbsp 3 times a day, and also instill 10 drops of decoction into the sore ear.

Otitis media can be cured with garlic, onions and birch bud infusion:

• infuse crushed garlic with vegetable oil within 10 days. Keep in the sun. Add glycerin to the resulting solution and instill a few drops into the ear. Before this, the solution should be warmed;
• After cutting off the top of the onion, make a depression in it and add cumin into it. Cover with the top and bake in the oven for half an hour. Then squeeze out; instill the resulting juice before bedtime for a week, 3 drops in the ear;
• 10% tincture of birch buds relieves inflammation and restores hearing. After moistening a cotton swab, insert it into the ear for 10-15 minutes. Repeat 3-4 times a day.

Poppy and herbal decoctions will help cure internal otitis:

• Boil 7 heads of unripe poppy seeds in 150 ml of milk for 30 minutes. Rinse the sore ear with the resulting decoction;
• pour 200 ml of boiling water with 1 tbsp mixed in equal parts of eucalyptus, yarrow, calendula and string. After steeping for half an hour, drink the infusion throughout the day.

The above recipes act as additional ones and do not replace drug treatment.

Prevention and restoration of hearing after otitis media

How can the occurrence of infection be minimized? Prevention of otitis in adults involves following simple rules.

1. Refrain from swimming in polluted waters.
2. After any contact with water, thoroughly clean your ears.
3. Regularly clean your ears from dirt and wax and maintain hygiene. But it is better to leave a minimum of sulfur, since it protects the ear canal from pathogenic microbes.
4. It is responsible to treat any ear and nose disease.

Advice! It is recommended to swim in rivers and open water using earplugs.

Often people treat otitis unjustifiably frivolously, not realizing that complications from this infection can lead to the most sad consequences. The information in this article will help you sensibly assess the dangers and risks of the disease, learn how to avoid it, and, if necessary, cure it.

Purulent otitis is a purulent inflammation localized in the air cavities of the middle ear. Occurs due to bacterial, fungal and viral infection. Acute purulent otitis is typical for any age category, but in most cases the disease develops in children.

Pathogenesis of the disease

The fundamental cause of purulent otitis is the spread of the infectious process from nasopharyngeal cavity to the middle ear. Where the infectious pathogen enters through the so-called rhino-tubar route. Much less often, pathogenic pathogens affect the middle ear cavity by penetrating through the external auditory canal, due to a violation of the integrity of the eardrum.

Also spicy medium acute otitis media may occur against the background of various diseases of the upper respiratory system, in the presence of adenoids in children and through the blood.

Reducing the body's resistance in diabetes mellitus and diseases infectious nature, renal failure increases the risk of inflammatory processes in the middle ear cavity.

Symptoms

Clinical manifestations of acute otitis depend on the degree of the disease. General symptoms indicating the occurrence of otitis media:

• purulent ear discharge;
• elevated temperature;
• pain in the ear area;
• aching headaches;
• frequent dizziness;
• hearing impairment;
• the specific smell of their ear.

The disease occurs in three stages:

• acute otitis media;
• catarrhal;
• reparative stage.

At the first stage, the symptoms of the disease are characterized by acute pain. The pain in this case can be very varied, both burning, squeezing, shooting, and pulsating, stabbing, aching.

Over time, constant pain, intensifying at night, interferes with proper sleep and significantly reduces the patient’s quality of life. Against the background of these pathological processes, a decrease in auditory perception develops and the general condition is disrupted. There is a significant increase in body temperature (38-39̊ C), which is difficult to reduce with the help of medications.

During the examination, hyperemia and pronounced swelling of the eardrum are observed. When palpating the mastoid process, acute pain is noted.

Purulent otitis media in the second stage is manifested by a rupture of the eardrum with purulent discharge. Symptoms become sluggish, pain subsides, the patient’s condition becomes better, and the temperature decreases.

In the absence of complications during the course of the disease, purulent otitis media of the middle ear flows into the third stage - recovery. At this stage, inflammation subsides, the process of suppuration ceases, and the symptoms completely disappear. Otitis media usually subsides after 2-3 weeks.

Diagnostics

Purulent otitis media is diagnosed using the following diagnostic measures:

• general medical history;
• examination of the ear cavity;
• endoscopic, tuning fork examination of the ear.
• acumetry to study auditory function;
• impedance measurement to determine the condition of the eardrum.

Treatment

Treatment of purulent otitis media should be carried out exclusively by a medical specialist. Taking into account the symptoms and manifestations of the general picture of the disease, the doctor may prescribe suitable treatment. The main therapeutic measures are:

1. Warm-up procedures. A fairly common treatment for purulent otitis media is carried out by heating. You should resort to this method of therapy with extreme caution and only with the consent of your doctor. Self-execution procedures are advisable in the absence of suppuration for the first time during the course of the disease.
2. If perforation of the eardrum does not occur on its own, surgery may be prescribed. Representing a cut (puncture) in the tissue of the eardrum. It is important to note that surgery must be carried out in as soon as possible, to avoid unwanted complications. However, otitis media is quite rarely treated in this way.
3. Purulent otitis media must be treated with the use of nasal vasodilating drops, which help relieve inflammation from the nasal and nasopharyngeal mucosa.
4. Treatment acute form Otitis of the middle ear is carried out using antibacterial therapy.
5. Purulent otitis media, accompanied by purulent discharge, is not recommended to be treated with thermal procedures. The use of alcohol-based ear drops is also prohibited, as they can damage the mucous membrane of the ear cavity.
6. The main aspect of therapeutic measures is the elimination of purulent discharge and cleansing of the ear canal. Will it effective treatment, largely depends on the implementation of this procedure. You can do it yourself, being careful. It is highly not recommended to use cotton swabs, matches, etc. for this purpose, as they can damage the mucous membrane and disrupt the integrity of the eardrum.
7. Treatment aimed at relieving pain involves the use of antispasmodics and analgesics. To reduce the temperature, the patient is prescribed antipyretic drugs.

Surgical treatment of acute otitis media is quite rare. In case of appointment surgical intervention, resort to the following operations:

1. Tympanostomy is prescribed if otitis media does not respond to drug treatment. Held this procedure by installing a special tube that helps facilitate the process of outflow of purulent discharge.
2. Myringotomy - treatment is aimed at opening the eardrum. They resort to this method if there is acute pain and pronounced symptoms.

Complications and consequences of the disease

If acute otitis media is not treated in a timely manner or if you try to start treatment on your own, you may develop serious complications. These include:

• spread of the infectious-inflammatory process to the bone located behind the auricle;
• the occurrence of otogenic sepsis;
• hearing impairment;
• rupture of the eardrum;
• flow into chronic form diseases;
• destruction of the auditory ossicles;
• tumor-like neoplasm – choleoasteatoma;
• infectious lesion of the lining of the brain.

Prevention

Preventive measures should primarily be aimed at timely treatment of viral infections. respiratory diseases. To prevent them and reduce the risk of occurrence, you should follow the following measures prevention:

• If possible, try not to overcool the body;
• dress according to weather conditions;
• observe the rules of personal hygiene;
• eliminate bad habits;
• do light exercise.

Treatment of acute respiratory diseases accompanied by rhinitis includes the correct technique of blowing the nose and rinsing the nasal cavity.

Acute otitis media, detected on early stage, can be treated much more quickly, so at the first manifestations of the disease you should immediately visit a doctor.